Abstract
BackgroundCommunity-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Among project participants, treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn, is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province.MethodsProject staff collected antibiotic exposure histories for 297 participants enrolled during 2007–2012 in Aklavik, Tuktoyaktuk, and Fort McPherson in the Northwest Territories, and Old Crow, Yukon. Medical chart reviews collected data on systemic antibiotic dispensations for the 5-year period before enrolment for each participant. Antibiotic dispensation data for urban Edmonton, Alberta (average population ~ 860,000) and rural northern Alberta (average population ~ 450,000) during 2010–2013 were obtained from the Alberta Government Interactive Health Data Application.ResultsAntibiotic dispensation rates, estimated as dispensations/person-years (95% confidence interval) were: in Arctic communities, 0.89 (0.84, 0.94); in Edmonton, 0.55 (0.55, 0.56); in rural northern Alberta, 0.63 (0.62, 0.63). Antibiotic dispensation rates were higher in women and older age groups in all regions. In all regions, the highest dispensation rates occurred for β-lactam and macrolide antibiotic classes.ConclusionsThese results show more frequent antibiotic dispensation in Arctic communities relative to an urban and rural southern Canadian population.
Highlights
Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities show frequent failure of treatment to eliminate the bacterium
The Canadian North Helicobacter pylori (CANHelp) Working Canadian North Helicobacter pylori Working Group (Group) links northern Canadian communities, health care providers and regional health officials with University of Alberta investigators to conduct community-driven research aimed at addressing concerns about health risks from H. pylori infection; the ultimate goal is to inform public health policy pertaining to control of H. pylori infection [7]
The aims of the current study are to describe antibiotic dispensation rates, as a measure of the frequency of overall exposure to systemic antibiotics, by community, sex, age and antibiotic class, in Canadian Arctic communities and compare these rates to those of urban and rural outpatient populations in the southern Canadian province of Alberta. These results will shed light on whether increased exposure to antibiotics is a potential explanation for reduced effectiveness of antibiotics in Indigenous Arctic populations, making them vulnerable to poor infection outcomes. This analysis includes participants in community H. pylori projects conducted by the CANHelp Working Group in 4 hamlets in the western Arctic region of Canada: projects launched in Aklavik, Northwest Territories (NT) in 2007, Old Crow, Yukon (YT) in 2010, Tuktoyaktuk (NT) in 2011, and Fort McPherson (NT) in 2012 [27,28,29,30,31,32,33,34,35,36,37,38]
Summary
Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn, is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province. Available data show stomach cancer rates to be elevated in Indigenous Arctic populations as well, [11,12,13] an occurrence of Williams et al BMC Public Health (2019) 19:949 great concern to affected communities and their health care providers
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